Strengthening Climate Services for the Health Sector in the Caribbean

The climate science community can play an important role in addressing public health challenges. Many human diseases and health conditions are sensitive to changes in temperature, precipitation, humidity, wind and other environmental conditions such as air and water quality. Climate information can thus be used as a sign of risk and to inform disease monitoring and health research. In some cases, it can be used to predict when and where disease outbreaks may occur, in relation to expected climate conditions.  

Tailored climate services can assist the health sector to make better decisions on how to allocate scarce resources (for example, finance, personnel, equipment and pharmaceuticals). They can help identify high-risk communities by monitoring environmental factors, alerting local communities and health providers to harmful conditions, and increasing awareness and preventive actions through education and training campaigns. The value gained by incorporating climate information into health decision-making processes can create more effective and efficient health services, thus reducing morbidity and mortality attributed to climate-sensitive health issues.

Climate services for health are an emerging field of applied science, defined as “the entire iterative process of joint collaboration between relevant multidisciplinary partners to identify, generate and build capacity to access, develop, deliver, and use relevant and reliable climate knowledge to enhance health decisions” (WMO/WHO, 2016).

Providing climate services for the health sector requires intensive collaboration. However, synergy between the health and climate communities does not necessarily occur naturally and may need to be catalysed and cultivated. Traditionally, there has been little investment in global issues related to climate and health, particularly in the Caribbean (WMO, 2014). This is not the case for other sectors, such as water, agriculture and disaster risk management, where the application of weather and climate services has been better documented and illustrated. However, many climate information products related to flood and drought, tropical cyclones, and extreme temperatures and heat, at a range of timescales (for example, hourly to decadal), have potential applications in the Caribbean health sector.

Demand for climate services for health in the Caribbean

The demand for a coherent and integrated approach to management of climate risks to human health underpins the objectives of the Global Framework for Climate Services (GFCS) Health Exemplar (WMO, 2014), which calls for:

1. Strengthened communication and partnerships among climate and health actors at all levels
2. Increased capacity of the health sector to effectively access, understand and use climate and weather information for health decisions
3. Improved health and climate research and evidence of the linkage of climate and health
4. Climate and weather data effectively mainstreamed into health operations

The need for investment in systematic collaboration between the climate and health communities is arguably greatest in highly vulnerable, cash-strapped small island developing States (SIDS). Such States are exposed to extreme weather and climate events, rising temperatures and changes in ocean and ecosystem conditions. These factors influence disease transmission and the determinants of good health, such as clean water, safe and sufficient food, local economy and safe housing.

In recent years, the Caribbean has experienced a high human and socioeconomic cost burden from extreme wind and rain events that directly threaten life, result in damage and loss to housing and health facilities, and contribute to psychosocial illnesses. Exposure to strong ultraviolet rays, which can result in skin damage, is also a concern in a region where tourism is a significant socioeconomic sector. In addition, multiple climate-sensitive diseases, such as those borne by the Aedes aegypti mosquito (dengue, chikungunya and Zika viruses), as well as rodent-borne and waterborne diseases associated with flood waters (including leptospirosis, cholera and other gastro-intestinal diseases) have become more prominent in the region. Health experts have also identified emerging health risks from extreme heat and elevated levels of Saharan dust, which can be monitored and forecast with the help of the meteorological community.

Vector-borne diseases

The recent unprecedented public health crisis of co-occurring epidemics due to viruses borne by the Aedes aegypti mosquito is a top health priority in the Caribbean. Illnesses due to the dengue, chikungunya and Zika viruses have increased rapidly over the last three decades, exacerbating the physical and economic strain on already stretched health systems. For example, since 2013, Barbados has experienced three outbreaks of dengue, one of chikungunya and one of Zika (Lowe et al., 2018). In 2016, when a global public health emergency was declared for Zika, Barbados reported 926 suspected cases of which 147 were positive, while Dominica reported 1 263 suspected cases of which 79 were confirmed (Ryan et al., 2017). In the same year, Barbados also reported 314 dengue-positive cases (including 15 dengue/Zika co-infections) and 3 chikungunya-positive cases (Ryan et al., 2018).

Extreme heat

Extreme heat exposure, particularly during acute heatwaves, has been shown to increase morbidity and mortality of vulnerable populations and to reduce workforce productivity. Long-term exposure to elevated day and night temperatures poses other types of physiological stress on the body. People with chronic non-communicable diseases, such as heart disease, stroke and diabetes, and those with mental health concerns face special challenges with thermoregulation compared to healthy adults. As the Caribbean continues along a trend of increasing temperatures (Stephenson et al., 2014), it has become of critical public health importance to better understand the impact of excess heat, heat spells and heat stress in populations with non-communicable diseases.

Saharan dust

Significant amounts of desert dust travel thousands of miles from the Sahara region to the Caribbean annually on prevailing upper level winds. This often results in many countries exceeding the World Health Organization and United States Environmental Protection Agency air quality standards for fine (PM2.5) and coarse (PM10) particulate matter. Episodes of acute sand and dust exposure are affected by global wind and precipitation patterns, and environmental and climate conditions in the Sahara, and have serious implications for respiratory and ocular health in the Caribbean. Persons who already suffer from asthma and allergic rhinitis may become increasingly symptomatic during periods of elevated dust and PM10 concentrations.

The Caribbean region can no longer sustain the high human and economic burden of treatment, and the lives and quality of life lost to these climate-sensitive diseases. Anticipating disease transmission with climate intelligence is thus a priority, to support implementation of preventive measures.

Increasing regional capacity to develop climate services for health

There has been widespread recognition of the climate–health linkages and the importance of public health. However, Caribbean SIDS have been slow to take advantage of the opportunity presented by the development and integration of climate services into national and health sector planning and practice. Many countries in the region have absent or weak institutional arrangements that stunt meaningful collaboration between the health and climate sectors. They also have few intersectoral platforms or meeting spaces for mutual sharing, lack localized integrated empirical studies linking climate and health outcomes, and have a paucity of health-specific climate information tools and resources to mainstream into health operations.

In recognition of the challenges faced by SIDS, WMO has designated them a primary beneficiary target group for the GFCS. From 2013 to 2017, WMO carried out the Programme for Building Regional Climate Capacity in the Caribbean (the BRCCC Programme), which was funded by the United States Agency for International Development (USAID). The technical arm of the Caribbean Meteorological Organisation – the Caribbean Institute for Meteorology and Hydrology (CIMH) – implemented the programme.

CIMH, a WMO Regional Climate Centre (RCC) since 2017, was then in the demonstration phase of becoming an RCC. As such, it was routinely producing regional climate products and services in collaboration with its regional network of National Meteorological and Hydrological Services (NMHSs). These included climate data management services, historical and reference climatologies, climate monitoring, long-range (seasonal) forecast products and climate watches.

The BRCCC Programme was intended to increase the relevance and reach of CIMH by developing, testing and disseminating a new generation of climate tools and information products to support Early Warning Information Systems across Climate Timescales (herein referred to as EWISACTs). There was to be special focus on decision-making information for health and other GFCS priority sectors, as well as for the Caribbean’s mainstay tourism industry.

The Caribbean’s sectoral EWISACTs focus is on full “end-to-end” integration between climate information and early sectoral decision-making related to climate risk management. It channels the GFCS vision of enabling societies to better manage the risks and opportunities arising from climate variability and change, through the development and incorporation of science-based climate information and prediction into planning, policy and practice (WMO, 2011).

In the climate information chain, this integration begins with analysis of climate-related vulnerabilities in the operational processes of end users. It continues with the co-development of products and services to address underlying vulnerabilities and then the co-delivery of user-defined climate impact prediction products and services at spatial and temporal resolutions required by end users. The idea is that focusing on meeting end-user needs for climate information and collaboratively developing products can enhance the quality of information available to sectors such as health, and also the uptake and use of tailored climate information.

Since 2015, CIMH has worked on an emerging, multipronged health–climate portfolio in collaboration with national and regional partners such as ministries of health, NMHSs, the Caribbean Public Health Agency (CARPHA), the Pan American Health Organization (PAHO) and other international, interdisciplinary research partners. The Caribbean experience in applying GFCS Health Exemplar principles to establish and strengthen these interscalar relationships at national, regional and international levels to advance health–climate services design, development and delivery in the Caribbean is described below.

Strengthening communication and partnerships

Figure 1. Consortium of Sectoral EWISACTs Coordination Partners – a group of six regional sector agencies and a regional climate service provider (CIMH) – committed to the co-design, co-development and co-delivery of user-specific and actionable climate information products.

CIMH began the process of integrating social science approaches with its traditional physical science approaches to improve the development and delivery of climate services under the BRCCC Programme. Researchers at CIMH conducted a comprehensive end-user baseline assessment, which allowed health practitioners to communicate their need for and capacity to use available climate monitoring and forecast information produced operationally by CIMH. This revealed that health practitioners consider the dry and wet seasons when developing their annual public health plans, but do not formally incorporate climate information into their planning process.

Given the embryonic status of the application of climate science in the Caribbean health sector, it was clear that the sector should be a target beneficiary of the next generation of climate services.

A key strategy pursued by CIMH has been the signing of formal agreements across institutions for collaboration in the development and integration of climate services in decision-making. This was underpinned by a desire to break away from the traditional mode of working in siloes towards a new model of inter-institutional collaboration for cumulative, integrated impact for sectoral climate services.

A Consortium of Sectoral EWISACTs Coordination Partners – a group of six regional sector agencies and a regional climate service provider (CIMH) – committed to the co-design, co-development and co-delivery of user-specific and actionable climate information products (Figure 1). CARPHA joined the Consortium in 2017 as the regional health partner, and is supported by PAHO in its activities.

Increasing the capacity of the health sector

Figure 2. Page 1 of the September 2018 issue of the quarterly Caribbean Health Climatic Bulletin

The development and operational dissemination of sector-specific climate bulletins increases the capacity of sectors to access, understand and use climate information. These bulletins routinely translate the potential risks and opportunities associated with seasonal climate monitoring and forecast information for specific sectors. The Consortium partners have been instrumental in developing the first generation of achievable sector-specific and actionable climate information products that synthesize and provide messaging on the implications of climate for sectors, using information from the existing suite of CIMH technical climate products.

The Caribbean Health Climatic Bulletin, launched in June 2017, is a product of the collaboration between CIMH, CARPHA and PAHO (Figure 2). The Bulletin provides an overview of the climate over the forecast period and information on recent climate conditions and events. Through health partners, it also provides insights on what health risks may be exacerbated due to observed and anticipated climate conditions. Thus, the Bulletin offers guidance on numerous climate-sensitive health issues, including respiratory illnesses, non-communicable diseases, vector-borne illnesses, gastro-intestinal illnesses, well-being and mental health. This information is intended to inform strategic and operational decisions related to health interventions and the management of health-care systems.

The Health Climatic Bulletin is available on the websites of the Caribbean RCC, CARPHA and PAHO.

Improving health and climate research

Initial evaluations indicate that health sector end users find the Health Climatic Bulletin useful. However, its health warnings are based on qualitative expert statements on probable health risks, which could be strengthened by integrating quantitative probabilistic forecasts of disease risk (Lowe et al., 2018). Thus, research is needed to develop more precise disease forecast products using climate information.

Climate services for vector-borne diseases

Work on heat health and sand/dust health has focused on enhancing understanding of the physical processes associated with extreme heat thresholds, as well as the dust cycle, to predict future events in the Caribbean. In contrast, work on vector-borne diseases has moved towards an integrated approach that is generating breakthroughs on the linkages between climate and diseases transmitted by the Aedes aegypti mosquito. Advances require interdisciplinary skills to integrate and analyse climate, entomological and epidemiological data – a skill set combination that was not readily available in the Caribbean. CIMH, in association with CARPHA, PAHO, ministries of health and NMHSs, engaged an interdisciplinary, international research team to address this gap.

Figure 3. Schematic showing type (for example, observed or forecast) of climate information needed to produce a dengue forecast in Barbados for the target month of October. Source: Lowe et al. (2018)

The team conducted a pilot study in Barbados and Dominica from February to July 2017 to develop a modelling framework. Outputs of this study provide evidence for the role of climate in seasonal and interannual variability in Aedes aegypti dynamics and dengue transmission. This lays the groundwork for developing a climate-driven early warning system for viruses transmitted by this mosquito in the Caribbean. To date, three research publications have emerged from the pilot study, sharing the results on arbovirus epidemiology and climate in the Caribbean with the wider international community. Novel early warning tools, which could be used by the public health sector to prevent and respond to concurrent vector-borne disease outbreaks (Figure 3), have also been developed.

Face-to-face workshops and technical webinars were convened with the Caribbean health and climate communities to build capacity, as part of the pilot study. Efforts are already under way to extend the scope of the research to additional Caribbean countries.

This work on vector-borne diseases demonstrates the feasibility of developing climate services for health and the importance of strong long-term partnerships across the climate and health sectors. The collaborative interdisciplinary model is likely to be replicated in the other health–climate priority areas being pursued by CIMH and its partners. When fully developed, the wide-ranging research outputs on diseases borne by Aedes aegypti, on extreme heat and non-communicable diseases, as well as on Saharan dust and respiratory illnesses, will eventually be included in the quarterly Caribbean HCB to provide climate-smart decision-making guidance for Caribbean health practitioners.

Mainstreaming climate and weather data effectively in health operations

Recent innovative research-to-operations advances, in tandem with the integration of social science oriented participatory approaches, are catalysing co-production of the next generation of climate services for health in the Caribbean. The region now has access to several early warning products related to human health. This includes a novel modelling framework to forecast the risk of dengue outbreaks using climate information, developed for Barbados (Figure 3). There is significant potential to operationalize the model and to extend it to other countries in the Caribbean as it uses climate indicators and forecasts routinely produced by CIMH. Thus, this research has put the Caribbean firmly on track to develop a climate-based early warning system for dengue and other mosquito-borne diseases in the region.

The next phase will focus on putting initial investments in health–climate research into practice. This will improve national and regional health outcomes by building further components required for an operational climate-driven health early warning information system. One will be the development of a modelling platform, based on a geographic information system, that integrates and analyses currently disparate streams of atmospheric, environmental, epidemiological, entomological and other socioecological data in a common database. These data will feed into a spatiotemporal prediction model that generates seasonal disease risk maps and/or outlooks that are linked to an epidemic alert and response system that serves as an evidence-based decision support tool for the public health sector.

The integration of these various research and development streams into health operations has great potential to reduce risks for climate-sensitive diseases that currently undermine the productivity and sustainable development of Caribbean SIDS.

Acknowledgements

Activities and progress on the Caribbean’s health–climate portfolio were supported by the USAID (Grant ID: AID-538-10-14-00001) BRCCC Programme with funding made possible by the generous support of the American people. R.L. was supported by a Royal Society Dorothy Hodgkin Fellowship. Many thanks to the other contributors of the Aedes aegypti climate research team: Sadie Ryan, Mercy Borbor, Moory Romero, Cédric van Meerbeeck and Shelly-Ann Cox. The authors are also grateful to Shermaine Clauzel, Lyndon Forbes Robertson and Avery Hinds (CARPHA) and Adrianus Vlugman and Karen Polson-Edwards (PAHO) for their continued support in co-delivering the Caribbean HCB. Thanks also to Andrea Sealy and Ashford Reyes (CIMH) for their leadership on the Saharan dust modelling portfolio.

References

Lowe, R., A. Gasparrini, C.J. Van Meerbeeck, C.A. Lippi, R. Mahon, A.R. Trotman, L. Rollock, A.Q.J. Hinds, S.J. Ryan and A.M. Stewart-Ibarra, 2018: Nonlinear and delayed impacts of climate on dengue risk in Barbados: a modelling study. PLoS Medicine, 15(7):e1002613, doi.org/10.1371/journal.pmed.1002613.

Ryan, S.J., C.J. Carlson, A.M. Stewart-Ibarra, M.J. Borbor-Cordova, M.M. Romero, S. Cox, R. Mahon, A. Trotman, S. St. Ville and S. Ahmed, 2017: Zika virus outbreak, Dominica, 2016. Emerging Infectious Diseases, 23(11):1926–1927.

Ryan, S.J., C.A. Lippi, C.J. Carlson, A.M. Stewart-Ibarra, M.J. Borbor-Cordova, M.M. Romero, S. Cox, R. Mahon, A. Trotman, L. Rollock, M. Gittens-St. Hilaire, D. King and S. Daniel, 2018: Zika virus outbreak, Barbados, 2015–2016. American Journal of Tropical Medicine and Hygiene, 98(6):1857–1859.
Stephenson, T.S., L.A. Vincent, T. Allen, C.J. Van Meerbeeck, N. McLean, T.C. Peterson, et al., 2014: Changes in extreme temperature and precipitation in the Caribbean region, 1961–2010. International Journal of Climatology, 34(9):2957–2971, doi.org/10.1002/joc.3889.

World Meteorological Organization, 2011: Climate Knowledge for Action: a Global Framework for Climate Services – Empowering the Most Vulnerable. The Report of the High-level Taskforce for the Global Framework for Climate Services (WMO-No. 1065). Geneva.

—, 2014: Health Exemplar to the User Interface Platform of the Global Framework for Climate Services. Geneva.

World Meteorological Organization/World Health Organization, 2016: Climate Services for Health Fundamentals and Case Studies for Improving Public Health Decision-making in a New Climate. Geneva.

Authors

Adrian Trotman, Caribbean Institute for Meteorology and Hydrology, Bridgetown, Barbados

Roché Mahon, Caribbean Institute for Meteorology and Hydrology, Bridgetown, Barbados

Joy Shumake-Guillemot, World Health Organization/World Meteorological Organization Climate and Health Office

Rachel Lowe, Department of Infectious Disease Epidemiology and Centre for the Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom of Great Britain and Northern Ireland; Barcelona Institute for Global Health, Barcelona, Spain

Anna M. Stewart-Ibarra, Institute for Global Health and Translational Science, SUNY Upstate Medical University, Syracuse, NY, United States of America